Send Radiographs For Review | Direct Veterinary Surgery

Patient Summary*

(Please include: signalment, chief complaint, onset, diagnostic summary, ruleouts, recommendations made to pet owner.)

Clinic Name*

Clinic Phone*

Clinic Email*

Clinic Contact Person*

Differential Diagnoses*

Open questions you would like addressed*

File

(Please attach pertinent radiographs, medical record notes, and diagnostic reports.)

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Accepted file types: doc, docx, pdf, jpg, png, Max. file size: 256 MB.

~~ You will receive a confirmation of receipt of this request today. A written radiographic surgical interpretation will be sent by email within 24 hours. Upon completion of radiographic case collaboration, an invoice for $75 will be sent to your clinic. ~~

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